Take comfort in the serendipity that wisdom and cataracts may have arrived at the same time. You’ve probably seen the words of The Serenity Prayer that — right there at the end — characterize wisdom as the ability to know the difference between the things you can and cannot change. Well, in a wonderful turn of events, the ability to change how perfectly you see without glasses for both reading and distance after cataract surgery has been moved by technology from the “cannot” list, over to the list of things you can change.
The diagnostic tools available to you today make the previous generations of technology seem comparatively imprecise. It is an impressive feat when you consider that the previous generation was still able to take measurements down to the hundredth of a millimeter. As computers have increased in speed and processing power, the precision achievable for intraocular lenses — and the calculations to choose them correctly — has made what once seemed impossible now seem routine.
There is a very good reason that refractive cataract surgery is one of the safest surgical procedures in medicine. It’s because it is one of the most common procedures in medicine. About three million cataract surgeries are performed in the U.S. each year. The good news is that this means the surgery is nearly unmatched in perfecting the safety protocols regulating it, the techniques developed for it, and the technology elevating it.
Sure, cataract surgery might be one of the most-performed surgeries in the world, but that doesn’t mean you don’t have concerns. We’ve compiled an extensive list of helpful answers to our most common cataract questions. If you’re a bit nervous about the prospect of lens surgery, you’ll likely find these answers reassuring. If you’re already feeling cool and collected, well, a little confidence boost can’t hurt.
Not to oversimplify it, but there are two ways to experience cataract surgery: go to an ambulatory surgery center and have an experience that is very similar what is involved in a major surgery, or fix the cataract in a vision correction suite that is designed to treat cataract surgery like the easy 15-minute procedure that it is. Some folks need a surgery center (and we’ll guide you through it if you do), but the vast majority don’t, and you deserve to find out if you qualify to have cataract surgery the way it was meant to be — simple.
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When it comes to trusting the people who fix your eyes, you’d probably prefer medical expertise to genuine kindness. But our goal is to keep you from ever having to make that choice. See what to expect.
The natural lens inside the eye cannot be seen. It sits behind the dark pupil, and is in a completely different compartment from the front of the eye. When that secluded, natural lens gets cloudy its name gets changed to a cataract. Cataract surgery simply involves removing that cloudy lens from inside the eye, and then placing a new clear intra-ocular lens (IOL) in its place. In the vast majority of cases, this involves 5 steps:
The Hunter Vision approach to vision correction, from the college student to the greatest generation, is simple. The best technology offers the best information, but it is only useful when it is used to meet each person's individual visual goals. Taking the time with each patient to decide what is best requires more than just the newest gadgets. It requires honesty, transparency, and genuine care for the people that walk through our door
For most of the history of cataract surgery over the last 50 years, there has been only one option for an intra-ocular lens (IOL). The plan for everyone, until recently, was just to get rid of the cloudy lens, (AKA cataract) and it was expected glasses were required following the surgery. Clear vision with glasses was the goal. People today were lucky enough to be born at the right time in history to have even better options than that. Here’s a brief summary of those choices:
Basic. This tried-and-true technique has been around for decades, giving wonderful results for tens of millions of patients. It involves removing the cataract inside the eye by phacoemulsification, and placing a clear IOL where the cataract once sat. The IOL used is determined by the measurements of the eye and is targeted to give the best distance vision possible. Patients who choose this option will possibly need glasses for distance and will definitely need glasses for intermediate (computer) and near (reading) vision. This procedure is considered covered by insurance and has no extra cost except a normal co-pay or deductible.
Precision Blending. Today, because of huge improvements in diagnostic imaging of they eye (as well as laser and IOL technology) it is possible to offer truly awesome precision in vision correction. This option is for those that want to have vision above and beyond what is possible with basic cataract surgery. Instead of it being just a medical procedure to provide clear vision with glasses, this is an elective option with the goal to provide clear vision without the need for glasses. To reiterate, it is possible to achieve distance, intermediate, and near vision without glasses just by using special diagnostics and IOLs; we think that's amazing. Since it is refractive (aiming to get a patient out of glasses), it is elective and has an out-of-pocket expense.
Premium IOLs. These IOLs are used to provide patients with superb near vision to go along with their distance vision. In general, this option is best for those primarily concerned with fine near work (e.g. fine print, cross stitching, circuitry work), and who don't have stringent requirements for night vision. For example, a jeweler whose livelihood is in the details of the very tiny and very near has different visual requirements than a pilot who flies primarily at night. Fortunately, there are IOLs created for all types of visual demands. We offer all of them, and Dr. Hunter spends time with each patient who wants a Premium IOL to help decide the best choice.
Cataract surgery wasn't always the beautiful, elegant procedure that it is today. Below, Dr. Hunter lays out the history of how the surgery evolved with time. So, as a fair warning, those who are squeamish may wish to move to another Hunter Vision web page. May we recommend this one?
The first attempts to remove the cloudy lens inside the eye date back to as early as thousands of years B.C. The technique was called couching; it involved an eye, a needle or thorn, and a "doctor" with a very strong stomach. The sharp instrument was pushed into the front of the eye, and then used to push the cloudy lens down into the vitreous (gel) inside the eye. As you can guess, it wasn't known for great results, with only about 30% not going blind by some estimates. It seems more likely to me that this was a technique used by Bronze-age doctors to keep people from complaining about their vision. I can imagine a Mesopotamian patient accidentally mentioning to his doctor that his eyes are getting bad, and then realizing his mistake. "Ha ha!" he'd say, "I meant to say my vision is quite good!" as he tries to rush out but mistakenly walks into a clearly marked supply closet.
It wasn't until the 20th century that things took a considerable leap forward. The three techniques that were developed over this time bring us to modern cataract surgery. They are intracapsular cataract extraction, extracapsular cataract extraction, and finally phacoemulsification. Really brilliant and innovative surgeons, along with brave patients that wanted to see well again, walked through these refinements over the decades so that life would be much easier for cataract patients (and surgeons!) today. That cataract surgery today is a joy, rather than a terror, is due to these greats. Like Newton said, we stand on the shoulders of giants. Now let's see what they accomplished.
The intracapsular cataract extraction was aptly named because the cataract was removed, capsular bag and all. The lens (which in this case is called a cataract) sits inside a capsule, which is held in place centered behind the pupil by thousands of spiderweb thread-like zonules. The zonules attach to the capsule edge on one side and the wall of the eye on the other side. So, to dissolve the zonules, a solvent called alpha-chymotrypsin was used. That is pancreatic juice; its normal job is breaking down food for digestion! Pressure was then applied to the eye to shoot the lens out of a large incision. Oftentimes, the patient was left with no lens and was instead given very powerful glasses (+20 or so!) or contacts. Complication rates were understandably high, but it was worlds better than couching, giving useful vision to the majority of patients.
In the next iteration of the process — extracapsular cataract extraction — the cataract was removed, but the capsule was left in place. The big advantage here was that now we had a great place to put the artificial intra-ocular lens (IOL), right where the old lens once was! Patients were given IOLs and because they were sitting in the right place, it was possible to achieve good to excellent vision longterm. The downside to this technique is that the lens still had to come out whole, and that requires a pretty big incision (10mm or more, which is almost the whole length from one edge of the iris across to the other). But when there weren't complications from the somewhat brutal surgery itself, people by and large were doing wonderful. Then a genius stepped in and changed everything.
Charles Kelman M.D. is cataract surgery's Einstein, or maybe Mick Jagger; it's hard to say because he was one of those polymaths that defies categorization. This was a man that pioneered modern cataract surgery, wrote broadway shows, flew his own helicopter, did Tonight Show appearances with Carson, and lived an all around huge life. He had an idea (after a visit to the dentist to get a cleaning) that the lens could be removed by breaking it up with ultrasonic energy. Although it took years to get it to work perfectly, he succeeded. Today, phacoemulsification has revolutionized cataract surgery. A tiny probe (less than 1/8th inch thick) vibrates several thousand times per second to effortlessly remove a cataract while doing no damage to the rest of the eye.
From there it has only been a few short steps to make cataract surgery what it is today: a 10-minute, outpatient procedure that has people back to their normal lives the next day. Complications are never impossible, but they are now rare or insignificant. There are no sutures involved, no pain, and people can see like they never thought possible. We are really lucky to live in the future.
Read our Cataract Surgery FAQ, or give us a call.